A Clinician’s Guide to the Pathophysiology of Traumatic Brain Injury

Traumatic brain injury (TBI) is a major cause of death and disability in children and young adults and has been identified as an important public health problem in the United States and worldwide 1-6. When head injuries of all severities are included, the age-related incidence has been estimated to be as high as 670/100,0007. Over the past 1520 years the reported incidence of TBI resulting from motor vehicle accidents has been declining steadily in the United States; whereas brain injury resulting from firearms has been on the rise, somewhat negating the benefits of better public education and improved motor vehicle safety8. Worldwide, motor vehicle accidents remain a major cause of TBI, and this problem is actually increasing, particularly in developing nations. TBI remains a major cause of traumarelated death and hospitalization. Approximately 2 million persons suffer TBI in the United States annually and of these about 70,000 to 90,000 will have permanent long-term disability, creating a significant socioeconomic and emotional burden on the families and society. The most commonly affected group is males 15-24 years of age, but children under the age of five and adults above the age of 65 also tend to be at increased risk6. In the U.S., pediatric TBI (under 14 years of age) is responsible for an estimated 3000 deaths, 29,000 hospitalizations and 400,000 emergency department visits annually4.